Healthcare Provider Details

I. General information

NPI: 1770562225
Provider Name (Legal Business Name): JANET K MYERS D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/12/2006
Last Update Date: 01/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

710 S BUSINESS HIGHWAY 61
BOWLING GREEN MO
63334-5239
US

IV. Provider business mailing address

710 S BUSINESS 61
BOWLING GREEN MO
63334-5239
US

V. Phone/Fax

Practice location:
  • Phone: 573-324-2063
  • Fax: 573-324-2167
Mailing address:
  • Phone: 573-324-2063
  • Fax: 573-324-2167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberR1F20
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: